Department of Health Systems Financing, World Health Organization, 1211 Geneva, Switzerland.
BMJ. 2012 Mar 2;344:e609. doi: 10.1136/bmj.e609.
To assess the comparative costs and effects of interventions to combat five neuropsychiatric conditions (schizophrenia, bipolar disorder, depression, epilepsy, and heavy alcohol use).
Cost effectiveness analysis based on an epidemiological model.
Two epidemiologically defined World Health Organization sub-regions of the world: countries in sub-Saharan Africa with very high adult and high child mortality (AfrE); and countries in South East Asia with high adult and high child mortality (SearD).
Published studies, costing databases.
Cost per capita and cost per disability adjusted life year (DALY) averted, expressed in international dollars ($Int) for the year 2005.
Across 44 assessed intervention strategies for the five neuropsychiatric conditions, cost effectiveness values differed by as much as two orders of magnitude (from $Int100-250 to $Int10,000-25,000 for a year of healthy life gained). In both sub-regions, inpatient based treatment of schizophrenia with newer antipsychotic drugs was the most costly and least cost effective strategy. The most cost effective strategies in the African sub-region related to population based alcohol control, while in the South East Asian sub-region the most cost effective intervention was drug treatment of epilepsy in primary care. The cumulative cost per capita of the most cost effective set of interventions covering all five conditions was estimated at $Int4.90-5.70. This package comprises interventions for epilepsy (older first line antiepileptic drugs); depression (generically produced newer antidepressants and psychosocial treatment); bipolar disorder (mood stabiliser drug lithium); schizophrenia (neuroleptic antipsychotic drugs and psychosocial treatment); and heavy alcohol use (increased taxation and its enforcement, reduced access, and, in the African sub-region, advertising bans and brief advice to heavy drinkers in primary care).
Reallocation of resources to cost effective intervention strategies would increase health gain, save money and help implement much needed expansion of services for neuropsychiatric conditions in low resource settings.
评估干预五种神经精神疾病（精神分裂症、双相情感障碍、抑郁症、癫痫和酗酒）的成本和效果。
基于流行病学模型的成本效益分析。
世界卫生组织两个流行病学定义的世界次区域：撒哈拉以南非洲国家，成人和儿童死亡率非常高（AfrE）；东南亚国家，成人和儿童死亡率高（SearD）。
已发表的研究，成本数据库。
以国际元（$Int）表示的人均成本和每避免一个残疾调整生命年（DALY）的成本，均为 2005 年的成本。
在所评估的 5 种神经精神疾病的 44 种干预策略中，成本效益值相差两个数量级（从获得一年健康生命的$Int100-250 到$Int10,000-25,000）。在这两个次区域，新型抗精神病药物治疗精神分裂症的住院治疗是最昂贵和最不具成本效益的策略。在非洲次区域，最具成本效益的策略与基于人群的酒精控制有关，而在东南亚次区域，最具成本效益的干预措施是在初级保健中对癫痫进行药物治疗。涵盖所有 5 种疾病的最具成本效益的干预措施的人均累计成本估计为$Int4.90-5.70。该方案包括癫痫（一线抗癫痫药物）；抑郁症（通用生产的新型抗抑郁药和心理治疗）；双相情感障碍（心境稳定剂药物锂）；精神分裂症（神经阻滞剂抗精神病药物和心理治疗）；和酗酒（增加税收及其执行力度，减少获得途径，在非洲次区域，在初级保健中对重度饮酒者进行广告禁令和简短建议）。
将资源重新分配给具有成本效益的干预措施将增加健康收益，节省资金，并有助于在资源匮乏的环境中扩大对神经精神疾病的服务。
